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Chapter 84 - Patient Simulators

Marcus Rall

David M. Gaba

How can clinicians experience the difficulties of patient care without putting patients at undue risk? How can we assess the abilities of clinicians as individuals and teams when each patient is unique? These are questions that have challenged medicine for years. Over the last 15 years, these and related questions have begun to be answered in health care by the application of approaches new to medicine, but borrowed from years of successful service in other industries facing similar problems. These approaches focus on "simulation," a technique well known in the military, aviation, space flight, and nuclear power industries.

Simulation refers to the artificial replication of sufficient elements of a real-world domain to achieve a stated goal. The goals can include understanding the domain better, training personnel to deal with the domain, or testing the capacity of personnel to work in the domain. The fidelity of a simulation refers to how closely it replicates the domain and is determined by the number of elements that are replicated and the discrepancy between each element and the real world. The fidelity required depends on the stated goals. Some goals can be achieved with minimal fidelity, whereas others require very high fidelity.

Simulation has probably been a part of human activity since prehistoric times. Rehearsal for hunting activities and warfare was most likely an occasion for simulating the behavior of prey or enemy warriors. Technologic simulation probably dates back to the dawn of technology itself. Good and Gravenstein^[1] point to the medieval quintain as a technologic device that crudely simulated the behavior of an opponent during sword fighting. If the swordsman did not duck at the appropriate time after striking a blow, he would be hit by a component of the quintain.

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